Flashcards in Non Depolarizing NMBs Deck (67)
What are the chemical properties of NDMBs?
-steroid derivatives or benzylisoquinolines
Tell me about the Benzylisoquinolines? Which ones are they? What is different about their metabolism?
Mivacurium, Cisatracurium, Atracurium
-inhibits uptake into hepatocytes leads to lack of liver eliminaton
What is the principle route of elimination of the NDMBs?
Which NDMBs have biliary excretion in addition to renal?
How is Atracurium metabolized? Cisatracurium? Mivacurium?
Atracurium:2/3 nonspecific ester hydrolysis and 1/3 Hoffman elimination
Cisatracurium: Hoffman elimination
Mivacurium: plasma cholinesterase
Which NDMBs cause histamine release?
Which NDMBs can cause tachycardia?
D-tubo (reflex tachy)
Which NDMBs can cause a drop in BP?
Which NDMB can cause and increase in BP?
Which drugs can prolong the NDMBs?
Antibiotics (aminoglycosides!, tetracycline, clindamycin, Cyclosporine)
Antidysrhythmics (procanamide, Quinidine)
Ca Channel blockers/corticosteroids (atracurium)
What can alter your response to NDMBs?
-hypothermia (prolongs block)
-Acidosis (inhibits hoffman elimination)
-Hypokalemia (prolongs effects)
-Burns (3rd degree bursn >30% of body have resistance to NDMBs (40-60 days post injury
What is the intubating dose of Rocuronium?
What is the Onset of Roc?
60-90 sec (1-2 min)
What is the DOA of Roc?
30-90 min (15 - 85 min)
What is the e 1/2 Life of Roc?
60-120 min (87 min)
What is the maintenance dose of Roc?
What patients should you avoid NDMBs?
-Hemiparesis/hemiplegia (affected side shows resistance as compared to the unaffected side
What is the dose of Vecuronium?
What is the Maintenance dose of Vec?
0.01-0.015mg/kg q 25-45 min
What is the cont. infusion dose of Vec?
What are the contraindications to NDMBs?
-Liver disease and renal disease are relative contraindications
Which patients should you use caution when using Pancuronium?
-pts with underlying CV disease
-hypokalemia, hypermagnesemia, severe hyponatremia, severe hypocalcemia potentiate blockade
-MG/ Myasthenic syndrome
-impaired renal function
What is the intubating dose of Pancuronium?
What is the maintenance dose of Pancuronium?
0.01 - 0.02 mg/kg q 20-60min
What is a contraindication to giving the benzylquinolines?
What is the dosage and onset of Mivacurium?
0.15 mg/kg and the onset is 2-3 minutes
What is the intubating dose of Cis-Atracurium?
0.1 5- 0.2 mg/kg IV
What is the maintenance dose of Cis-atracurium?
0.02 mg/kg IV
What is a major side effect of Cis-Atracurium and Mivacurium? When is this a concern?
Laudanosine production which can cause Seizures; may accumulate in Renal failure